Cytoreduction and Hyperthermic Intraperitoneal Paclitaxel and Cisplatin for Gastric Cancer with Peritoneal Metastasis

Buckarma, EeeLN; Thiels, Cornelius A.; Jin, Zhaohui; Grotz, Travis E.

doi:10.1245/s10434-023-14379-2

Cited by 5 publications

(4 citation statements)

References 40 publications

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“…Today, through the intraperitoneal administration of drugs, it is possible to reach the sites of PM, which was previously not possible with systemic CMT alone because of the peritoneal blood barrier [ 28 , 29 ]. This modality has resulted in improved survival, as well as an increase in conversion rates, but only in well-selected patients with GC with PM [ 4 , 5 , 11 , 12 , 17 , 28 ]. In a retrospective cohort study of patients with ECOG0/1 who had GC and PM with a median PCI of 4 (IQR, 2–9), one-third of the patients treated with laparoscopic HIPEC ultimately proceeded to cytoreduction and gastrectomy [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…Recently, in light of the need for additional therapies in the setting of peritoneal dissemination, the evolution and refinement of treatment options—such as cytoreductive surgery (CRS), hyperthermic intraperitoneal chemotherapy (HIPEC), pressurized intraperitoneal aerosol chemotherapy (PIPAC), and normothermic intraperitoneal chemotherapy—has generated new interest in the treatment of gastric PM [ 4 , 9 , 11 , 12 ]. Conversion therapy emerged as an alternative treatment for these patients, which included the administration of systemic CMT with intraperitoneal CMT followed by surgery [ 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

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Risk Scoring System to Predict Mortality in Gastric Cancer with Peritoneal Carcinomatosis

Pereira,

Ramos,

Charruf

et al. 2024

Medical Sciences

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Gastric cancer (GC) with peritoneal carcinomatosis (PC) has a particularly unfavorable prognosis. This limited survival raises doubts about which factors confer an extremely worse outcome and which patients could benefit from more aggressive treatments, in an attempt to improve survival and better control the disease. This study aimed to evaluate the survival outcomes of patients with PC due to GC and develop a prognostic score to predict 6-month mortality. We performed an analysis of clinical stage IV GC with PC. Scores were assigned to risk factors and calculated for each patient from nine variables. Among 326 IVB GC, 211 (64.7%) had PC and were included. After calculating the score, 136 (64.5%) GCs were classified as a low-risk group and 75 (35.5%) as a high-risk group. Median OS was 7.9 and 1.9 months for low- and high-risk patients (p < 0.001). In the high-risk group, 77.3% of the patients died in <6 mo (p < 0.001). Palliative surgery and chemotherapy were associated with better survival, and the prognostic groups maintained statistical significance even when the same type of treatment was performed. In conclusion, the scoring system developed with variables related to patient performance status and clinical data was able to distinguish GC with PC with a high risk of 6-month mortality. Accordingly, verifying and validating our findings in a large cohort of patients is necessary to confirm and guarantee the external validation of the results.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Risk Scoring System to Predict Mortality in Gastric Cancer with Peritoneal Carcinomatosis

Pereira,

Ramos,

Charruf

et al. 2024

Medical Sciences

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“…This technique can classify patients with GC at diagnosis, indicating a poorer prognosis for those with positive cytology in PLF. Therefore, it is advisable to implement preemptive interventional measures such as hyperthermic intraperitoneal chemotherapy (HIPEC) for this high-risk population ( Lei et al, 2020 ; Jain & Badgwell, 2023 ; Buckarma et al, 2024 ; Xu & Wang, 2023 ). Our follow-up research plan is to treat FCCs-positive patients with HIPEC (using nab-paclitaxel) and compare their outcomes to those of FCCs-positive patients not receiving HIPEC and FCCs-negative patients, to explore the preventive effect of HIPEC on patients with OPM.…”

Section: Discussionmentioning

confidence: 99%

Positive peritoneal lavage fluid cytology based on isolation by size of epithelial tumor cells indicates a high risk of peritoneal metastasis

Xuan,

Gao,

Wang

et al. 2024

PeerJ

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Background Peritoneal metastasis (PM) is the most prevalent type of metastasis in patients with gastric cancer (GC) and has an extremely poor prognosis. The detection of free cancer cells (FCCs) in the peritoneal cavity has been demonstrated to be one of the worst prognostic factors for GC. However, there is a lack of sensitive detection methods for FCCs in the peritoneal cavity. This study aimed to use a new peritoneal lavage fluid cytology examination to detect FCCs in patients with GC, and to explore its clinical significance on diagnosing of occult peritoneal metastasis (OPM) and prognosis. Methods Peritoneal lavage fluid from 50 patients with GC was obtained and processed via the isolation by size of epithelial tumor cells (ISET) method. Immunofluorescence and fluorescence in situ hybridization (FISH) were used to identify FCCs expressing chromosome 8 (CEP8), chromosome 17 (CEP17), and epithelial cell adhesion molecule (EpCAM). Results Using a combination of the ISET platform and immunofluorescence-FISH, the detection of FCCs was higher than that by light microscopy (24.0% vs. 2.0%). Samples were categorized into positive and negative groups, based on the expressions of CEP8, CEP17, and EpCAM. Statistically significant relationships were demonstrated between age (P = 0.029), sex (P = 0.002), lymphatic invasion (P = 0.001), pTNM stage (P = 0.001), and positivity for FCCs. After adjusting for covariates, patients with positive FCCs had lower progression-free survival than patients with negative FCCs. Conclusion The ISET platform highly enriched nucleated cells from peritoneal lavage fluid, and indicators comprising EpCAM, CEP8, and CEP17 confirmed the diagnosis of FCCs. As a potential detection method, it offers an opportunity for early intervention of OPM and an extension of patient survival.

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“…There were two RCTs [8,29], three non-randomized clinical trials [14,23,28], and 19 nonrandomized retrospective cohort studies [9][10][11][12][13][15][16][17][18][19][20][21][22][24][25][26][27]30,31]. All non-randomized studies scored 7 or more on the Newcastle-Ottawa scale, and both the n-RCTs and RCTs had a low risk of bias according to Robin-I and Robin 2.0.…”

Section: Studies' Risk-of-bias Assessmentmentioning

confidence: 99%

Efficacy of Cytoreductive Surgery (CRS) + HIPEC in Gastric Cancer with Peritoneal Metastasis: Systematic Review and Meta-Analysis

Langellotti,

Fiorillo,

D’Annibale

et al. 2024

Cancers

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Background: Peritoneal carcinomatosis is one of deadliest metastatic patterns of gastric cancer, being associated with a median overall survival (OS) of 4 months. Up to now, palliative systemic chemotherapy (pSC) has been the only recommended treatment. The aim of this study is to evaluate a potential survival benefit after CRS + HIPEC compared to pSC. Methods: A systematic review was conducted according to the PRISMA guidelines in March 2024. Manuscripts reporting patients with peritoneal carcinomatosis from gastric cancer treated with CRS + HIPEC were included. A meta-analysis was performed, comparing the survival results between the CRS + HIPEC and pSC groups, and the primary outcome was the comparison in terms of OS. We performed random-effects meta-analysis of odds ratios (ORs). We assessed heterogeneity using the Q2 statistic. Results: Out of the 24 papers included, 1369 patients underwent CRS + HIPEC, with a median OS range of 9.8–28.2 months; and 103 patients underwent pSC, with a median OS range of 4.9–8 months. CRS + HIPEC was associated with significantly increased survival compared to palliative systemic chemotherapy (−1.8954 (95% CI: −2.5761 to −1.2146; p < 0.001). Conclusions: CRS + HIPEC could provide survival advantages in gastric cancer peritoneal metastasis compared to pSC.

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Cytoreduction and Hyperthermic Intraperitoneal Paclitaxel and Cisplatin for Gastric Cancer with Peritoneal Metastasis

Cited by 5 publications

References 40 publications

Risk Scoring System to Predict Mortality in Gastric Cancer with Peritoneal Carcinomatosis

Risk Scoring System to Predict Mortality in Gastric Cancer with Peritoneal Carcinomatosis

Positive peritoneal lavage fluid cytology based on isolation by size of epithelial tumor cells indicates a high risk of peritoneal metastasis

Efficacy of Cytoreductive Surgery (CRS) + HIPEC in Gastric Cancer with Peritoneal Metastasis: Systematic Review and Meta-Analysis

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